Lipid Management Case Study: Lab Interpretation for Nurse Practitioners

Lipid panels can be deceptively confusing!
Which guidelines to use? What numbers to treat? There are so many medication options!
In this video, using a case study, you'll learn:
- Who to test
- How to decide who gets treatment (and what kind)
- When to follow up
IMPORTANT NOTE: this applies for non-pregnant adults only, and statins are contraindicated in pregnancy, so be mindful when managing patients of childbearing age/potential (see comments).
This applies to the VAST majority of patients in primary care, BUT, if you want the whole she-bang when it comes to lipid management (high triglycerides, secondary prevention, coronary calcium scores, etc), consider join the Lab Interpretation Crash Course! Join at www.realworldnp.com/labs
---------------------
Resources I mentioned:
Algorithm flowchart for who to test/treat: tools.acc.org/ASCVD-Risk-Estim...
Intensities of statin therapy: tools.acc.org/ASCVD-Risk-Estim...
Risk enhancing factors to help you decide if someone is "intermediate risk": tools.acc.org/ASCVD-Risk-Estim...
---------------------
Don't forget to grab your free Ultimate Resource Guide for the New NP at www.realworldnp.com/guide
More Resources:
Lab Interpretation Crash Course: www.realworldnp.com/labs
Digital NP Binder: www.realworldnp.com/binder
Diabetes Medication Workshop: www.realworldnp.com/diabetes
------------------------
Come follow along for even more tips and inspiration:
Instagram: / realworldnp
Facebook: / realworldnp

[@queenaura1]

What a wonderful breakdown of screening and treatment!

[@RealWorldNP]

Glad you enjoyed it.

[@burgerwolfrn4191]

This is great! Thank you!

[@RealWorldNP]

You're very welcome!

[@chinaricanbeast5228]

I like these Case Studies, thanks Liz! : )

[@RealWorldNP]

You're so welcome!

[@lacedizz]

Bless you for this. In NP school and in clinical and trying to get my bearings. Its so hard. You make it make a little more sense. So thankful for you.

[@RealWorldNP]

You are so welcome.

[@PrincessAisha2006]

Great video Liz. What do we do for patients under 40, who we can’t calculate Asvcd risk on? And childbearing women who statin therapy may be harmful?

[@RealWorldNP]

Awesome questions!! Thank you so much. Excellent point about childbearing women. It's so important to be cautious about medications that can be teratogenic, and I recommend it be a frank conversation with patients, but we don't necessarily withhold them altogether UNLESS they are trying to conceive. I.E. Acutane -- plenty of women of childbearing age take this medication, we just have a conversation about the risks of teratogenicity and advise reliable contraception (using tiered recommendations, LARCs first, then the less effective, etc etc.). That said, if someone is high risk for unintentional pregnancy, in my personal practice I'd advise them that I don't recommend taking it. Another thought is that it's all about the long term risk -- the effects over the course of 10 years, so if they are seeking pregnancy, it's not necessarily going to be harmful to NOT take a statin for that year + where they are pregnant/breastfeeding, etc. Also, if they need statins, they are likely high risk pregnancies anyway, and I tend to rely on maternal fetal medicine team for support around medication decision making (because they likely have DM , HTN, or smoke to put them in a statin-qualifying category). Under 40, it's a bit of a complicated discussion -- has to do with: is it familial? Is it because of DM 1 or 2? Is it dietary? Typically I always start with identifiable causes (DM, obesity, lifestyle) and take it from there if it's still high-- it's not super common, I'd recommend consulting with your supervisor if it comes up (I do!!)

[@Mafor4403]

I can’t thank you enough

[@RealWorldNP]

I am glad it's helpful!

[@knoelleh]

Hi Liz - this is great! Do you have a cheat sheet available for the highlights that are listed towards the end of this video? I do have the binder and I am in the lab course - just started.

[@RealWorldNP]

Hi there! There is a ton of resources in the lab course under lipids.

[@leticiab503]

Hi, enjoyed watching. Do you ever take patient's off statins? I meet a patient that apparently their provider took off statin therapy? How do you go about that ? Also, I wanted to say, i havent been able to receive the guide ? thanks

[@RealWorldNP]

Hey! For the guide, you can go to realworldnp.com/guide, and if it's still not working, send an email to [e-mail] The main reason to remove a statin is risk/benefit -- they're having severe side effects, or their life expectancy and risk of side effects is supportive of continued use! It depends on the person but typically those are lifelong aside from when you're thinking about taking off of medications related to life expectancy

[@leticiab503]

@@RealWorldNP that’s what I thought I was really wondering on the reasons for taking someone off the medication as this person suggested ? Thanks a lot I will send an email now . Haven’t been able to get it

[@nastya7988]

This is great! Are there any phone apps that you would recommend for NPs?

[@RealWorldNP]

Yes!! I've got a whole bunch in the free resource guide: realworldnp.com/guide

[@carterri04]

LDL is only a significant factor for risk assessment for coronary disease if Trigs are high and HDL is low. I thought everybody knew this by now.

[@RealWorldNP]

Thanks for your feedback.

[@ariasanders7834]

Am I missing something, if LDL is the most important why do you not plug it into the risk calculator? I have been neglecting LDL this whole time. 🤦🏻‍♀️

[@ariasanders7834]

I have been using a risk calculator that doesn’t ask for LDL.

[@RealWorldNP]

Hmm, this is the risk calculator that I use, I'd argue the LDL is the MOST important! tools.acc.org/ASCVD-Risk-Estimator-Plus/